Chapter 06: Building Pharmacy Administration, Recruitment and a Supportive Care Mindset

Title

Chapter 06: Building Pharmacy Administration, Recruitment and a Supportive Care Mindset

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Identifier

AndersonR_01_20040518_C06

Publication Date

5-18-2004

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Overview; Leadership; On Leadership; Overview; Research; MD Anderson Culture; Multi-disciplinary Approaches; Institutional Processes; Devices, Drugs, Procedures; The Business of MD Anderson; The Institution and Finances; Building/Transforming the Institution; Working Environment

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Disciplines

History of Science, Technology, and Medicine | Oncology | Oral History

Transcript

Roger W. Anderson, PhD:

Yeah, the clinical specialist has been a huge area of growth and by design -- my design of where pharmacy really needs to be going.

Lesley Williams Brunet:

Yeah, let’s talk about it now and then I’ll come back to my other questions. I know I -- I think I even brought an article about, I think it was a British author from [guys in] St. Thomas and he seemed surprised by the extent to which the clinical specialist coordinators were involved in prescribing.

Roger W. Anderson, PhD:

Yeah, that’s correct.

Lesley Williams Brunet:

And so, tell me how this --

Roger W. Anderson, PhD:

All right. Well, what we have done is, first of all, the clinical specialists have advanced training. Now it’s a little complicated these days when you think of the word Pharm.D. That’s the degree they have, the doctor of pharmacy degree. Because that was always, up until the last two years, it was an add-on additional degree to their pharmacy degree. It was a two year program on top of their baccalaureate degree which was a five year degree. So, and now, still, the distinguishing thing is that they have at least two years of post-graduate residency training. So these people, though, and the reason it’s confusing is, today as of the last two years, every pharmacist that graduates from any college of pharmacy has the Pharm.D. degree. So now it’s an entry level degree but those people that graduate today with the Pharm.D. still need the two years post-graduate residency to get into one of our clinical specialty positions.

Lesley Williams Brunet:

And when you went to school, you did your residency as part of your (overlapping dialogue; inaudible) --

Roger W. Anderson, PhD:

Yeah, I did it in a different way. The residency that we’re talking about with these people is a full clinical residency. My residency was hospital pharmacy practice in relatively management focus. Versus, today, these residents are pharmacy practice and then specialty, like oncology.

Lesley Williams Brunet:

Oh, OK. A specific specialty.

Roger W. Anderson, PhD:

Yeah. There are I think six different specialties. And oncology is one of -- the biggest one of those and one that we have residents in here, also, for future training. Which, you know, I instituted in, I think it was 1980-something. We’ve got the certificate up there that I can look at the exact date when we started that. But anyway, back to the role. So we have over the years added several of these positions to the point where we have 40 today.

Lesley Williams Brunet:

And when did this first start?

Roger W. Anderson, PhD:

Well, you can kind of think that when McKinley hired his first drug information specialist. That was the starting. But really it was probably in the mid -- the early ‘80s that I started hiring more and more of these clinical specialists and then assigning them -- and that’s been, I think, the point of success. They have been assigned completely to the medical departments and they don’t have to do any staffing in the pharmacy. They don’t have to work, you know, so many hours dispensing drugs. They are 100% clinically using their knowledge. That’s their job. The cognitive transformation of information, not drug distribution. So we started adding them over those years, and through they years we’ve added three full or whatever per year, generally, to the point where we have 40 of them today. What they do, they go to the medical area, they become part of that medical team, and they are relied upon -- and it’s grown. This reliance has grown over the years. At first they were sort of proposed to just be there and to answer questions as would come up while on rounds or on the unit or in the clinic. Well, it became more and more evident to the medical staff members that they knew a lot about drug therapy, so as time has gone on, the doctors now, when they get done with their diagnosis of whatever the issues are, they now turn to these pharmacists and say, OK, you prescribe. So this patient has X infection, what’s the best antibiotic? You write it. Or what’s the best anti-nausea medication, or what’s the best growth factor for blood cell returning to normal or whatever. And I would say about 75% of all the non-chemotherapy -- now, they do a lot with chemotherapy, too, but 75% of the non chemo-therapy orders today, throughout, they prescribe.

Lesley Williams Brunet:

That’s really inter-- and this is the supportive care of the --

Roger W. Anderson, PhD:

This is supportive care. Now, chemotherapy they enter into the development of the protocol, the design of the protocol, but then once that’s set and through all the approval process, then they will help the physician enter the patient on that protocol but basically the so-called prescribing of the chemotherapy is done by the protocol. Now, they’ll physically get that done, but you know, chemotherapy is really one of the things that certainly is completely in the purview of the physician and that’s correct. But the supportive care is relatively delegated today to the -- and we have formal legal prescription ther-- drug therapy management approval by the state board of pharmacy for these pharmacists to do that, and then nurses can take those orders, and in fact, pharmacists, our other pharmacists, can take those orders and fill them with the same authority as the physician.

Lesley Williams Brunet:

Now these didn’t replace the pharmacologists, say, that were working with, DT or --

Roger W. Anderson, PhD:

No, in reality most of those people are relatively bench people, bench research, more than in the clinic or on the ward or in the patient units. The [council-called] pharmacologists really were not too often seeing patients. Some might have been, people like Bill Plunket [oral history interview] and other people might have been involved some with that. But no, they didn’t replace, they added to. And on major services like leukemia, bone marrow transplant, today we have six of these people on each of those two services and then depending on the drug intensity of the other services we apply the other numbers. Like I think we have four in breast and four in GI and you know, so it’s pretty much now allocated throughout all of the medical areas and a couple surgical areas, too, but mostly medical.

Lesley Williams Brunet:

Now, you make this sound like it evolved very agreeably, but did it really?

Roger W. Anderson, PhD:

Yeah.

Lesley Williams Brunet:

I guess in the early days --

Roger W. Anderson, PhD:

No, in the early days, I am sure we had some resistance. They’re not really too much real open but there were probably some physicians that accepted it much more readily than others and we just let it prove itself. That’s all we did. It was a gamble, sort of. I mean, I knew it was going to work, but it was a gamble. So we just put them out very quietly and now it’s to the point, though, and this is an interesting thing, and it’s great. Now it’s to the point where the physicians want more and more of these people. So now it’s to the point where physicians come to my desk and make proposals for adding positions to their services and provide justification just like I used to provide to the administration as to why we needed these. Like, you know, the importance on safety and the importance on communication. The importance on all of these things that these pharmacists do and now that’s the emphasis of these physicians, not really worrying about drug turnaround time, even though they still would be if we weren’t doing a good job with that. But they’re coming in here making proposals, and then when I make my budget proposal to the administration, they are at that same table doing it, sort of, for me or with me.

Lesley Williams Brunet:

That’s very helpful.

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